Samplenj Continuation Letter

Date

SampleNJ Continuation Letter

Employee Name

Address

Dear (Employee name):

On (date), the following “qualifying event” occurred: (terminated employment). This “qualifying event” will result in the termination of employee benefits coverage for (you and/or your dependents) under our company plan (policy number) effective (date of termination). However, you and your dependents may elect to continue your present (medical only) coverage according to your rights under New Jersey Group Continuation.

You may elect N.J. continuation at your own expense.

This continuation coverage will be identical to the coverage provided at the time of the qualifying event. Any modification made to the employer’s policy will also apply to the employee with continuation coverage. Coverage and the related cost will end in accordance with the contract provision and N.J. Continuation rules.

An employee may elect to continue coverage for himself / herself and any of his / her then insured dependents. Otherwise coverage would end at his time. For dependents to be eligible to continue coverage, the employee must elect to continue health coverage for himself / herself. Continuation coverage will end automatically after 18 months or if the employer stops providing group benefits: or if the continued individual does not make the payments in time.

If continuation is elected, the payment due for employee/employee & dependents coverage is $ (enter monthly cost) per month. This premium is due on (date; ex 1st of the month) each month.

In order to continue coverage, the enclosed election form (application) must be completed and returned to me within 30 days of the qualifying event. In addition to the completed application, a payment equal to 1 month premium must be submitted in order for the election to be processed. All subsequent payments are due on the day of the month your election starts (ie. If continuation starts on the 12th of the month, your payment is due on the 12th of each subsequent month). You are allowed a 30 day grace period but coverage will be cancelled the day payment is due if payment is not received on the due date, and then re-instated upon receipt of check (if received during the grace period).

Sincerely,

Employer